Congestive heart failure

Heart failure exists when the heart is unable to pump the amount of blood needed by the body or when the pressure needs to be increased to meet the needs of the organism.

Acute congestive heart failure is a serious condition and one of the most common causes of emergency treatment.

The heart is divided into four rooms. The right atrium receives carbon-dioxide-rich blood from the upper and lower vena cava. The blood then flows into the right ventricle of the heart and enters the lungs via the pulmonary artery.
The left atrium receives oxygenated blood from the pulmonary vein and pumps it into the left ventricle. After that, it flows into the aorta and into the whole body.

With a decrease in function of the left ventricle, the heart is not able to pump a sufficient amount of blood.
This disorder is called heart failure.

As a result of heart failure, the tissues suffer because of the limited availability of oxygen.

This disease is rare in adolescents, but it occurs more frequently in older people.


Types of heart failure

Heart failure is divided into two categories: systolic and diastolic.

  • Systolic heart failure occurs when the cardiac pumping power decreases. It is measured by the “ejection fraction”: a number that takes into account the volumes of blood found in the heart. In systolic heart failure, the ejection fraction is ≤ 40%.
  • Diastolic heart failure occurs when the heart stiffens during diastole (phase in which the heart muscles relax and the chambers fill with blood). The heart does not fill completely with blood. This pathology is diagnosed by means of Doppler sonography. The ejection fraction is normal or greater than 55% in diastolic insufficiency. Women develop this condition more often than men.

Low-flow heart failure is caused by overuse of the heart due to high blood pressure (hypertension) or myocardial changes:

  1. Heart muscle disease
  2. Disorders of cardiac conduction or heart rhythm
  3. Myocardial infarction

Heart failure with high cardiac output (HCV) is caused by a persistent increase in diastolic ventricular pressure. It is usually caused by:

  1. Anaemia
  2. Hyperthyroidism
  3. Paget’s disease
  4. arteriovenous fistulas
  5. Conditions such as pregnancy

Retrograde heart failure occurs when a ventricle can no longer pump enough blood. This increases blood pressure and leads to fluid retention.

Anterograde heart failure occurs due to a reduction in renal blood flow caused by lack of emptying of the left ventricle of the heart.
In general, anterograde and retrograde heart failure occur together.

Causes of congestive heart failure

Heart failure can be associated with diseases that affect the heart’s ability to provide blood to the tissues.
Older people have an increased risk of suffering from this disease: with age, all muscles become weaker, including those of the heart.

  1. Coronary arteries are blood vessels that supply blood to the heart. When a plaque narrows these arteries, they can no longer carry enough blood to the heart, resulting in heart failure.
  2. High blood pressure (or hypertension) puts a strain on the heart, which has to pump with greater force. The muscle might not be able to do this extra work. The risks of myocardial infarction, stroke or heart failure are increased.
  3. Myocarditis is an inflammation of the heart muscle. It is usually caused by a viral infection that weakens cardiac action and can lead to congestive heart failure or a heart attack.
  4. Congenital heart disease is a structural abnormality of the heart that exists from birth.The defect may exist on the heart wall or on the heart valves. The result could be abnormal blood flow in the muscle.
    Congenital heart defects cause heart failure in children.
  5. Cardiomyopathy is characterized by weakness of the heart muscle. The disease complicates effective pumping of blood.
  6. Cardiac arrhythmia refers to an abnormality in the frequency of heart muscle contractions. It is characterized by an irregular heartbeat and is caused by abnormal electrical activity of the heart.
  7. Hyperthyroidism exists with excessive production of the thyroid hormone thyroxine. Hyperthyroidism accelerates metabolism and causes an irregular and accelerated heartbeat. It can also increase blood pressure.
  8. Heart failure may also be associated with damaged heart valves, hemochromatosis, amyloidosis, anemia, exposure to toxins, cocaine and chemotherapeutic agents.

Risk factors

✦ Age
✦ Abuse of alcohol and smoking ✦ Obesity ✦ Sedentary lifestyle ✦ Hypertension ✦ Diabetes
✦ Family predisposition to heart failure ✦ Metabolic syndrome ✦ Diet rich in cholesterol and saturated fat
✦ Excessive salt consumption ✦ Anxiety, stress and depression

✦ Previous heart attacks

Signs and symptoms of acute congestive heart failure

The inability of the heart to pump oxygen-rich blood is manifested in various symptoms. Heart failure can be acute or chronic. In acute heart failure, symptoms develop suddenly and worsen rapidly. The signs of chronic heart failure develop gradually. Signs of this condition include:

  1. Shortness of breath
  2. Weakness
  3. Swollen ankles and legs
  4. Accelerated heartbeat (the heart increases beats to compensate for the lower amount of blood pumped)
  5. Sudden body weight gain (due to edema)
  6. Cough
  7. Ascites or accumulation of fluid in the abdominal cavity
  8. Chest pain
  9. Nausea and loss of appetite
  10. Micturition decrease
  11. Pulmonary edema (fluid in the lungs)
  12. Difficulty breathing while lying down
  13. Renal failure
  14. Lack of concentration
  15. Persistent cough with reddish sputum
  16. Atrial fibrillation (is a complication that often occurs)
  17. Enlarged liver

Symptoms worsen in the advanced stage of congestive heart failure.

Heart failure is one of the heart diseases that can lead to sudden cardiac death.

Differences Between Right Heart and Left Heart Failure

The general symptoms of heart failure occur in both areas of the heart, but there are some characteristics that can tell whether the cause affects the right or left heart.

1. Left heart failure affects aortic blood flow, which is directly associated with blood flow to the brain and body. When this side is affected, the patient feels out of breath. The person seems exhausted, without energy and complains of chest pain. If it is a left heart attack, the whole thing is accompanied by tachycardia (increased heartbeat), facial pallor, cold extremities and sweating. In connection with this heart disease, pulmonary edema may occur.

2. If the right area of the heart is affected, the patient feels weakness and fatigue. The person is short of breath (also weak) and coughs.

Other characteristic symptoms include:

  1. Stomach ache
  2. Loss of appetite
  3. Chest pain
  4. Anorexia

The phases of acute congestive heart failure

Acute congestive heart failure is a progressive condition that worsens over time. When deteriorated, it also affects other organs of the body, such as lungs and kidneys.

After a first silent period, a slight weakness is observed, but this does not affect the daily activities of life.
As a result, all everyday activities can become difficult.
This phase is characterized by fatigue and cardiac palpitations.
If the disease progresses, it becomes difficult for patients to perform their tasks.
The abnormal heartbeat can be noticed even under low physical exertion.
At this stage, the heart does not function properly and the whole body suffers.
In the fourth (final) stage, heart failure is refractory, i.e. it no longer responds to any therapy. The daily activities of the patient are severely impaired.

The patient’s symptoms are shortness of breath, swollen feet and persistent cough.
At this stage, the patient is in the final stage.

Diagnosis of acute congestive heart failure

The symptoms of congestive heart failure can be confused with signs of other respiratory diseases.
Doctors assess the patient’s condition through physical and instrumental examinations.
It is necessary to exclude diseases that have similar symptoms to COPD (Chronic Obstructive Pulmonary Disease).

Examinations and tests that are carried out are:

  • Echocardiography
  • Electrocardiogram (ECG)
  • Cardiac stress test
  • Pulmonary function test
  • Chest X-ray (may show heart size and the presence of pleural effusion)
  • Angiography
  • Magnetic resonance tomography
  • Blood test
  • Urine test (in case of insufficiency, the specific gravity of urine is increased due to reduced renal blood flow)

BNP: test for the heart

BNP is a protein hormone that plays an important role in regulating circulation. BNP promotes the dilation of blood vessels and the excretion of salt and water via the kidneys, it helps to lower blood pressure and reduces the workload of the heart.

The blood is examined and the amount of BNP (Brain Natriuretic Peptide) is measured. This parameter is used to determine whether the patient has cardiac disease. A healthy heart beats slowly and promotes blood to the body’s organs.
A diseased heart muscle has to work harder and the heart beats faster to pump a sufficient amount of blood.
The more the heart struggles, the more the heart chambers produce BNP.
If the concentration of BNP in the blood is high, the person could suffer from congestive heart failure. If the patient has heart disease, the test allows the effect of a treatment to be evaluated.

Normal values of BNP in the blood
If the value is less than 100 pg/ml (picograms per milliliter), there is no need to worry. Values above 400 pg/ml indicate that there is a 95 % chance of having an infarction; further tests are obligatory if the value is between 100 pg/ml and 400 pg/ml. A normal level is assumed to be between 0.5 and 30 pg/ml.

There is a certain probability of false positives.
People with kidney disease could also have elevated BNP levels. A physiological increase in BNP is given in advanced age.

Treatment of acute congestive heart failure

At the initial stage, acute congestive heart failure can be treated with medication. ACE inhibitors (angiotensin-converting enzyme) are taken for blood vessel dilation and improve blood circulation.
Beta-blockers serve to reduce elevated blood pressure. Digitalis improves heart muscle strength.

The doctor often prescribes diuretics to more easily flush water and salt out of the body, for example, furosemide (Lasix).
Some medications, such as anti-inflammatory drugs, are not suitable and should be avoided. The patient’s condition is checked at regular intervals.

Treatment of elderly people consists of surgery if they do not respond to drug therapy.
Coronary bypass surgery leads to dilation of the coronary arteries.
If the heart is very weak and the heart rate is lowered, pacemakers can be used. In very serious cases, a heart transplant is required.

Natural treatments include a diet of foods low in fat and salt. You should limit the consumption of alcohol and caffeine, stop smoking and maintain an appropriate body weight.
It is important to drink a limited amount of water – no more than 1.5 liters – because the kidneys are unable to cope with a larger amount.

How long can you live? Prognosis

Mortality from this disease is about 20% of diagnoses.
50% of patients die within 5 years.

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